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Abstract
Objective The study investigates the trends in health-related inequalities in paid employment among men and women in different educational groups in 26 countries in 5 European regions.
Design Individual-level analysis of repeated cross-sectional annual data (2005–2014) from the EU Statistics on Income and Living Conditions.
Setting 26 European countries in 5 European regions.
Participants 1 844 915 individuals aged 30–59 years were selected with information on work status, chronic illness, educational background, age and gender.
Outcome measures Absolute differences were expressed by absolute differences in proportion in paid employment between participants with and without a chronic illness, using linear regression. Relative differences were expressed by prevalence ratios in paid employment, using a Cox proportional hazard model. Linear regression was used to examine the trends of inequalities.
Results Participants with a chronic illness had consistently lower labour force participation than those without illnesses. Educational inequalities were substantial with absolute differences larger within lower educated (men 21%–35%, women 10%–31%) than within higher educated (men 5%–13%, women 6%–16%). Relative differences showed that low-educated men with a chronic illness were 1.4–1.9 times (women 1.3–1.8 times) more likely to be out of paid employment than low-educated persons without a chronic illness, whereas this was 1.1–1.2 among high-educated men and women. In the Nordic, Anglo-Saxon and Eastern regions, these health-related educational inequalities in paid employment were more pronounced than in the Continental and Southern region. For most regions, absolute health-related educational inequalities in paid employment were generally constant, whereas relative inequalities increased, especially among low-educated persons.
Conclusions Men and women with a chronic illness have considerable less access to the labour market than their healthy colleagues, especially among lower educated persons. This exclusion from paid employment will increase health inequalities.
- trend analysis
- social inequalities
- chronic illness
- employment
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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Footnotes
Contributors JLDS prepared the data, conducted the analysis and drafted and revised the paper. MS and KMOH participated in the analysis and commented on the paper. AB conceptualised the study, participated in the analysis and commented on the paper and is the guarantor. All authors approved the final version.
Funding This work was conceived with financial support from award no. 208060001 by ZonMW within the Joint Programming Initiative More Years Better Lives (WORKLONG project) framework. Additional financial support was received through EIT Health.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Anonymised, non-identifiable participant-level survey data are freely available for academic researchers after successful application from Eurostat.
Correction notice This article has been corrected since it first published online. The open access licence type has been amended.
Patient consent for publication Not required.